ACEI/ARB use was found to be independently associated with AKI stage ≥1 (OR, 3.28 [95% CI, 2.17–4.94]; P<0.0001).  

Michigan State University

A retrospective longitudinal cohort study at a French university hospital was conducted to test the "harmful" and "beneficial" ACE-I/ARB hypotheses.  59 biomarkers were screened for in severe COVID-19 patients during their hospital stay, and these data were used to assess the association between chronic ACE-I/ARB use and kidney, lung, heart, and liver dysfunctions and inflammation.  It was concluded that this cohort was at an increase risk for acute kidney injury (AKI), and the observed increased in urea nitrogen was associated with the development of acute respiratory failure.    

Chronic ACE-I/ARB Use Is Associated with Acute Kidney Injury (AKI) in Severe COVID-19 Patients

Oussalah, A., Gleye, S., Clerc Urmes, I., Laugel, E., Callet, J., Barbé, F., Orlowski, S., Malaplate, C., Aimone-Gastin, I., Maatem Caillierez, B., Merten, M., Jeannesson, E., Kormann, R., Olivier, J., Rodriguez-Guéant, R., Namour, F., Bevilacqua, S., Losser, M., Levy, B., Kimmoun, A., Gibot, S., Thilly, N., Frimat, L., Schvoerer, E., & Guéant, J. (2020). Long-Term ACE Inhibitor/ARB Use Is Associated With Severe Renal Dysfunction and Acute Kidney Injury in Patients With Severe COVID-19: Results From a Referral Center Cohort in the Northeast of France. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa677

Long-Term ACE Inhibitor/ARB Use Is Associated with Severe Renal Dysfunction and Acute Kidney Injury in Patients with severe COVID-19: Results from a Referral Center Cohort in the North East of France

Acute Kidney Injury (AKI) Diagnoses Over Time In Severe COVID-19 Patients Taking ACE-I/ARBs

6 of the 12 dichotomous biomarker variables and the AKI stage were significantly different between severe COVID-19 patients depending on their ACEI/ARB use:

- urea nitrogen >0.52 g/L
- AKI stage ≥1,
- total bilirubin ≤5.8 mg/L
- phosphorus >40 mg/L
- creatinine >10.1 mg/L
- partial pressure of carbon dioxide [PCO2] >39 mmHg
- potassium >4.43 mmol/L

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